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A New Approach to Recognize Neonatal Impaired Kidney Function.

Sofia Perazzo1, Mary Revenis1,2, An Massaro1,2

  • 1Division of Neonatology, Children's National Hospital, Washington, DC, USA.

Kidney International Reports
|December 11, 2020
PubMed
Summary

New methods using serum creatinine (SCr) decline rates and thresholds can identify newborns with impaired kidney function (IKF) missed by standard neonatal acute kidney injury (nAKI) definitions. This helps in monitoring high-risk infants in the NICU.

Keywords:
acute kidney injuryfirst week of lifeneonaterenal functionserum creatinine

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Area of Science:

  • Neonatology
  • Pediatric Nephrology
  • Critical Care Medicine

Background:

  • Neonatal acute kidney injury (nAKI) is often diagnosed using standard definitions that may miss cases of impaired kidney function (IKF).
  • Previous research suggested that serum creatinine (SCr) decline rates in the first week of life could identify IKF in term newborns with hypoxic-ischemic encephalopathy.

Purpose of the Study:

  • To test the hypothesis that combining SCr decline rates with SCr thresholds can sensitively identify both term and preterm newborns with IKF within the first week of life.
  • To identify a group of newborns with IKF missed by current nAKI diagnostic criteria.

Main Methods:

  • Retrospective review of medical records for 329 critically ill newborns (≥27 weeks gestational age) admitted to a level 4 NICU.
  • Analysis of SCr decline rates and specific SCr thresholds to identify IKF in different gestational age groups.
  • Comparison of outcomes (hospital stay, ventilation, medications) between neonates with IKF, nAKI, and controls.

Main Results:

  • An SCr decline <31% with SCr ≥0.7 mg/dl identified IKF in newborns 31-40 weeks GA.
  • An SCr decline <21% with SCr ≥0.8 mg/dl identified IKF in newborns 27-30 weeks GA.
  • Neonates with IKF (17%) and nAKI (7%) had longer hospital stays and required more intensive interventions compared to controls. Urine output changes were not distinguishing.

Conclusions:

  • The combination of SCr decline rate and SCr thresholds effectively identifies newborns with IKF during the first week of life.
  • This method identifies a distinct group of neonates with IKF who are not recognized by standard nAKI definitions.
  • These infants require close monitoring in the NICU to prevent complications and manage potential renal issues.